DISSOCIATION (CONVERSION) DISORDER FORMERLY HYSTERIA
Download
Report
Transcript DISSOCIATION (CONVERSION) DISORDER FORMERLY HYSTERIA
DR.M IMRAN AFZAL
MBBS,DPM
(DIPLOMAT PSYCHOLOGICAL
MEDICINE)
C.PSYCH (MISSOURI) USA
DAYTOP GRADUATE (USA)
CONSULTANT PSYCHIATRIST
PUNJAB INSTITUTE OF MENTAL
HEALTH,
SHADMAN, LAHORE.
DISSOCIATION (CONVERSION) DISORDER
FORMERLY HYSTERIA
Disorder of sudden dramatic symptoms
Inconsistent with known diseases
“Unconscious” process---not malingering
Symptoms may present singly or en masse
EPIDEMIOLOGY
Incidence reported as 22 per 100,000
5 to 15 % of psychiatric consultations in a
general hospital
Ratio of men to women is 1 to 2
Men mostly involved in occupational and
military accidents
Common age is adolescents and young
adults
Common among rural populations, little
educated persons, those with low IQ, low
socioeconomic groups and military
personnel exposed to combat situations
CO MORBIDITY
Commonly associated with major
depressive disorder , anxiety disorders and
schizophrenia
ETIOLOGY
Psychoanalytic factors
Conflict is between an instinctual impulse an the
prohibitions against its expressions
Biological factors
Brain imaging shows hypo metabolism of the
dominant hemisphere and hyper metabolism of the
non dominant hemisphere
Excessive cortical arousal
Neuropsychological tests reveal cerebral
impairments in verbal communication,
memory , vigilance , affective incongruity
and attention
Psychological
•
•
•
•
Amnesia
Identity confusion
Trance
“Possession” states
CLINICAL FEATURES
Paralysis
Blindness
Mutism
SENSORY SYMPTOMS
Anaesthesia
Paresthesia
Stocking and glove anaesthesia of the hands and
feet
Hemi anaesthesia of the body along the midline
MOTOR SYMPTOMS
Abnormal movements
(choreiform,tics,jerks)
Gait disturbance
Weakness
Paralysis
SEIZURE SYMPTOMS
Pseudo seizures are common
Pupillary and gag reflexes are retained after
pseudo seizures
No post seizure increase in prolactin levels
Co existing epileptic disorder
ASSOCIATIVE FEATURES
Primary gains
Secondary gains
Avoiding difficult life situations
Receiving support and assistance
Controlling others’ behaviour
La belle indifference
DIFFERENTIAL DIAGNOSIS
Epileptic fit
Physical conditions causing similar symptoms
Neurological illnesses esp. multiple
sclerosis,myopathies guillain-barre
syndrome,early neurological symptoms of AIDS
Atypical depression
Unexplained somatic complaints
Anxiety disorders
MANAGEMENT
Good history taking
Advice and support to the patient and family
• Symptoms have no clear physical cause
• Can be brought about by stress
• Symptoms usually resolve rapidly leaving no
permanent damage
PSYCHOLOGICAL HELP
Encourage the patient to acknowledge recent
stresses
Give positive reinforcement
Take brief rest from stress before returning to
usual activities
Advise against prolonged rest or withdrawal
from activities
MEDICATION
Anxiolytics
Use of ammonia ??
Anti depressants
Referral to psychiatric facility